Background: In South Africa, occupational health services are delivered in a fragmented and complex environment. There is, however, a global emphasis on high-quality, universal occupational health coverage.
Objective: To describe occupational health practitioners' perceptions of the accreditation of occupational health services.
Methods: We used a mixed methods approach, which combined a self-administered web-based survey of 475 occupational health nurses and 11 semi-structured focus group discussions, which included a broad selection of occupational health stakeholders.
Results: The majority of respondents supported the statutory accreditation of healthcare services for workers, provided that a phased approach is used. Challenges that need to be addressed for a successful and sustainable accreditation system include the current lack of national standards for occupational health, human resource shortages, potentially high costs of accreditation, and the suboptimal and fragmented governance of occupational health services.
Conclusion: The majority of respondents were of the opinion that statutory accreditation of occupational health services will improve the quality of service delivery. However, prerequisites for successful and sustainable implementation of accreditation include improved collaboration between Government departments, coalition building with all stakeholders, the development of specific standards against which a service can be assessed, and education and training of occupational health practitioners to meet the established standards.

Background: The jobs of teachers involve high demand and low control, which predisposes them to psychological distress. Differences in the basic infrastructure in rural and urban areas may influence the psychological health status of teachers.
Objective: We assessed the prevalence of psychological distress and associated work-related factors among secondary school teachers in rural and urban areas of southwest Nigeria.
Methods: A cross-sectional analytical study design was utilised. Teachers from rural (n = 578) and urban (n = 596) areas were selected using multistage sampling. So-ciodemographic and occupational characteristics were recorded, and the 12-item General Health Questionnaire (GHQ-12) was used to assess psychological distress, using a cut-off score of ? 3 to indicate distress. Data were analysed using SPSS version 23. Chi-square analysis was used to test for differences between categorical variables and Student's t-test was used to check for differences in means. Logistic regression analysis was conducted to determine predictors of psychological distress. Statistical significance was set at 5%.
Results: Rural-based teachers were significantly younger than those in urban locations (p = 0.013), had fewer mean years of work experience (p = 0.043), taught larger class sizes (p < 0.000), had more financial dependants (p = 0.001), and spent less time at work each day (p < 0.000). More rural- than urban-based teachers had other jobs in addition to teaching (p = 0.023). Overall, 38.1% of the teachers were psychologically distressed: 42.7% in rural and 33.6% in urban schools (p = 0.001). Factors associated with psychological distress were being married (p = 0.007), teaching in a public school (p = 0.007), and teaching > 5 subjects (p < 0.001). The adjusted odds of psychological distress were higher in teachers in rural schools (AOR 1.30, 95% CI 1.02-1.67), and in public schools (AOR 1.58, 95% CI 1.19-2.11). The adjusted odds increased by 19% for every additional subject taught, and by 2% for every hour spent teaching.
Conclusion: Teachers in rural schools had more psychological distress than those in urban ones. Distress was associated with both individual and work-related characteristics. Teachers' work conditions in rural schools need to be improved to provide an incentive for them to work and remain in remote areas.